connecting worlds workbook

8/8/2019 Connecting Worlds Workbook

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PARTICIPANT

WORKBOOK

Training for Health Care Interpreters


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CONNECTING WORLDS PARTIC IPANT WORKB

PARTICIPANT WORKBOOK

TABLE OF CONTENTS

ACKNOWLEDGEMENTS

ABOUT THE CONNECTING WORLDS CURRICULUM

UNIT 1 5 ASSIGNMENTS RECORD

UNIT 1

Pre-Session Introduction With The Provider and Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Ad-Hoc Interpreter Children: Voices for Their Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Ad-Hoc Interpreter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Case Study 1: Ad-Hoc Interpreter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Case Study 2: Ad-Hoc Interpreter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Modes of Interpreting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Standardized Interpreting Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Start, Stop and Continue Reflection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Respiratory System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Nervous System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Vocabulary Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

UNIT 2

Roles of the Health Care Interpreter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Message Converter and Message Clarifier Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Practice Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Self-Assessment of Standard Interpreting Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Self-Assessment of Message Converter Role and Interventions . . . . . . . . . . . . . . . . . . . . . . 34

Self-Assessment of Three Steps for Stepping Out of the Message Converter Role . . . . . . . . . 36

Self-Assessment of Message Clarifier Role and Interventions . . . . . . . . . . . . . . . . . . . . . . . 38


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CONNECTING WORLDS PARTIC IPANT WORKBOOK

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Digestive System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Endocrine System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41


Vocabulary Words for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

UNIT 3

Health Beliefs and Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Issues of Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Heart Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Eye Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Auditory System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55


Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

UNIT 4

Patient Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Ethical Dilemmas: Words Can Be Harmful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Ethical Dilemma Questions: First Encounter Between Interpreter and Receptionist . . . . . . . . 64

Ethical Dilemma Questions: Second Encounter Between Interpreter and Receptionist . . . . . . 67

Consent Forms and Anti-Discrimination Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Guidelines for Sight Translation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70


Skeletal System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Urinary Tract System Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Female Reproductive Organs Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Male Reproductive Organs Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76


Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78


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UNIT 5

Professional Challenges and Staying Healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81



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The Connecting Worlds curriculum would not have been possible without the valuable contributions

of numerous individuals and organizations. We extend our sincere gratitude to each of the

organizations and individuals mentioned below. To any individuals or organizations we may have

inadvertently overlooked, please accept our apologies.

CONNECTING WORLDS PARTNERSHIP

Asian Health Services (Oakland)

Linda Okahara

Hong Vu, MA (former staff)

Clinicas de Salud del Pueblo (Brawley)

Healthy House Within a MATCH Coalition (Merced)

Marilyn Mochel, RN

Betty Moore, MLS (former staff)

Tatiana Vizcaino-Stewart

Palee Moua

Special Service for Groups/PALS for Health (Los Angeles)

Susan Choi, MS

Heng L. Foong

Nobuko Jane Hiramine (former staff)

Elizabeth Anh-Dao Nguyen (former staff)Chia-Rhu Yang

Vista Community Clinic (San Diego)

Linda L. Medal, MA

ACKNOWLEDGEMENTS


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The Connecting Worlds curriculum benefited from significant and generous contributions from all

collaborative partners. Special thanks to the following for authoring and developing the various

sections of the curriculum: Linda Okahara Trainer Manual and Participant Workbook; Hong Vu,

MA Trainer Manual, Participant Workbook, daily evaluations, graphics and layout design;

Marilyn Mochel, RN Trainer Manual Supplemental section (case studies and Laddermodel); David Nakashima, MS Trainer Guide; Tatiana Vizcaino-Stewart and Chia-Rhu Yang

scripted role-plays; and Nobuko Hiramine for editing of initial drafts. Charlotte Chang and Amy

Huang provided valuable editing and proofreading assistance of the final version. Special thank

yous are extended to Sarah Siu and Sylvia Park for their administrative support.

Consultants

Our deep appreciation is extended to David R. Nakashima, MS, who provided a) expert facilitation

in bringing five organizations to agreement on curriculum content and approach and b) curriculum

development and writing expertise. We would like to thank Holly Mikkelson, MA, for providing

consultation and assistance around the curriculums content on memory development. Alice

Chen, MD, MPH, George Lee, MD, Edeane Matsumoto, MD, and Balaram Puligandla, MD, provided

input and review of selected patient-provider scripted role-plays. Grace Fung, Phuong An Doan

Billings, Amy Choy-Kwan, Joann Wong, MPH, Judit Marin, MA, and T. Bergenn provided invaluable

input for the development of patient-provider scripted role-plays.

Previous Curriculum Development

This curriculum benefited immensely from previous contributions to the field of training health care

interpreters. In particular, we are grateful to the pioneering curriculum development and training

efforts of the Cross Cultural Health Programs Bridging the Gap: A Basic Training for Medical

Interpreters. In addition, we express our gratitude to Cynthia E. Roat, MPH for her important contri-

bution to the field with the development of the Incremental Intervention Model, which is incorporated

into this curriculum. This curriculum benefited greatly from the contributions of Laurin Mayeno,

MPH, original author of the Asian Health Services Across Language and Culture: A Training for

Health Care Interpreters and Ann Chun, MA, who made numerous revisions to the curriculum.

Funding

The California Endowment provided the funding to make this statewide training collaborative possible

through its Workplace Diversity and Cultural Competency portfolio. We are deeply appreciative

of the leadership provided by Robert Ross, MD, CEO, and Jai Lee Wong, former Senior Program

Officer and Manager of the Southern California Region, Alice Chen, MD, MPH, and Ignatius Bau, JD,

in guiding the establishment of this visionary community investment portfolio. Many thanks are

also extended to Sakinah Carter, MPH, Program Assistant, for her support of our efforts.


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Purpose

The purpose of this curriculum is to provide bilingual participants with:

1. An introduction to the theory, concepts, and skills related to the consecutive mode of

health care interpreting,

2. An appreciation for the complexities of the roles and responsibilities of interpreters in the

health care setting and the skills required to carry out those functions,

3. An introduction to ethical principles, considerations, and strategies to assist participants

in determining how to handle the challenges that arise within the interpreting context, and

4. Limited opportunities to apply concepts and theory through simulated interpreting sessionsand case studies.

Training Design and Philosophy

The Connecting Worlds curriculum is comprised of three pieces:

1. Trainer Manual

2. Participant Manual

3. Participant Workbook

The Connecting Worlds curriculum strives to provide a unique forum for participants to share

and learn from each others experience, knowledge and skills. Our approach is to engage

participants as active learners and teachers by involving them in interactive learning modalities

including group discussions, case study analysis, and role-plays. To the extent possible, a

concerted effort was made to provide students with opportunities to apply the theories, concepts,

techniques, and strategies presented throughout the training. While the Trainer Manual leaves

room for personal training styles, the expectation is that all learning objectives of the curriculum

will be met in order for a training to be called a Connecting Worlds training.

ABOUT THE CONNECTING WORLDS CURRICULUM


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Incorporation of California Standards for Health Care Interpreters

The California Standards for Health Care Interpreters developed by the California Healthcare

Interpreting Association are incorporated into the Connecting Worlds training curriculum. We felt

it was important to align this statewide training curriculum with the statewide per formance

standards, which were developed by the interpreting community throughout California. To theextent possible, we have referenced the CHIA Standards where they relate to specific training

topics or sections and we have attempted to be consistent with the labels used to describe

the roles of the interpreter. However, we must caution that this relatively short curriculum is

not able to address all aspects of the CHIA standards. We cannot claim that this training will

fully prepare participants to meet the standards.

Bilingual Proficiency Required

It is important to note that for health care interpreters to effectively perform their responsibilities,

they must possess a high degree of proficiency in English and their language(s) of service. The

Connecting Worlds training is conducted in English. Participants are provided limited opportunities

to practice and develop medical terminology in English and language(s) of service. However, this

training does not assist individuals with developing language proficiencies.

Limitations of the Curriculum

A 40-hour training curriculum can only hope to introduce participants to the basics of health care

interpreting. The Connecting Worlds Partnership often faced the very difficult decision of having to

delete or allocate little time to various training topics. Very limited time is available for participants

to actually practice the skills and strategies introduced and many important topics and issues

are not addressed at all within this curriculum. We have attempted to address some of these

limitations by building in homework assignments and time to review assignments. Our vision is

to eventually develop add-on modules that can be used to augment this introductory curriculum.

The curriculum was developed and various sections piloted by the partner organizations. Since

then, each of the partner organizations have implemented the curriculum for their particular needs

and audiences. Unfortunately, this publication does not reflect the many lessons learned from those

experiences. However, the partner organizations are most likely able to provide recommendations

and suggestions based on their experiences with the curriculum.


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This training is not a language course or a course on medical terminology. While limited medical

terminology is introduced in this training, more extensive study is required to effectively provide

health care interpreting. While homework assignments provide students with some exposure to

human anatomy, it is very limited. Human physiology is not at all addressed by the curriculum.

Encourage Continuing Education

Given the limitations of the curriculum and for many other good reasons, we highly encourage

interpreters to seek out continuing education opportunities to broaden exposure to a fuller

scope of interpreting issues and skills development. Through this training program, our hope is

that participants will begin to engage in their own self-assessment and seek out and organize

continuing-education opportunities.

Additional Copies

Additional copies of this curriculum may be obtained through The California Endowment,

1-800-449-4149.

Copyright

The Connecting Worlds curriculum is copyrighted by The California Endowment. No part of this

publication may be reproduced without the permission of The California Endowment.


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UNIT 1-5 ASSIGNMENTS RECORD

Unit 1 Assignment RecordDue:

Pre-Session Introduction with the Provider

Pre-Session Introduction with the Patient

Ad-Hoc Interpreter - Children: Voices for Their Parents

Ad-Hoc Interpreter Questions

Case Study 1: Ad-Hoc Interpreter

Case Study 2: Ad-Hoc Interpreter

Modes of Interpreting Standardized Interpreting Practices

Start, Stop and Continue Reflection

Respiratory System Diagram

Nervous System Diagram

Vocabulary Words

Other:


Roles of the Health Care Interpreter

Barriers

Message Converter and Message Clarifier Interventions

Practice Exercises

Self-Assessment of Standard Interpreting Practices

Self-Assessment of Message Converter Role and Interventions

Self-Assessment of Three Steps for Stepping Out of the Message Converter Role

Self-Assessment of Message Clarifier Role and Interventions

Digestive System Diagram

Endocrine System Diagram

Vocabulary Words

Vocabulary Words for Pain

Taping

Other:


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Health Beliefs and Practices

Confidentiality

Issues of Confidentiality Heart Diagram

Eye Diagram

Auditory System Diagram

Vocabulary Words

Taping

Other:


Patient Advocacy

Ethical Dilemmas: Words Can Be Harmful

Ethical Dilemmas Questions: First Encounter Between Interpreter and Receptionist

Ethical Dilemmas Questions: Second Encounter Between Interpreter and Receptionist

Consent Forms and Anti-Discrimination Laws

Guidelines for Sight Translation

Start, Stop and Continue Reflection

Skeletal System Diagram

Urinary Tract Diagram

Female Reproductive Organs Diagram

Male Reproductive Organs Diagram

Vocabulary Words

Taping

Other:


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Professional Challenges and Staying Healthy

Practice

Start, Stop and Continue Reflection Other:


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CONNECTING WORLDS PARTIC IPANT WORKBOOK : UN

PRE-SESSION INTRODUCTION WITH THE PROVIDER AND PATIENT


UNIT 1

Write your pre-session introduction to the English-speaking provider Dr. Barker. This is the first

time you are working with her, so remember to include all of the required information presented in

the training. Practice saying the introduction so that it can be said quickly and from memory. Be

prepared to share your introduction at the next training session.


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Write your pre-session introduction to the non-English speaking patient. This is the first time you

are working with him, so remember to include all of the required information presented in the

training. Give the patient an appropriate title and name in your language of service. Practice

saying the introduction so that it can be said quickly and from memory. Be prepared to share

your introduction at the next training session.

Title/Name:

CONNECTING WORLDS PARTIC IPANT WORKBOOK : UNIT 1

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Read the following article. Be prepared to discuss the questions that follow in the next training session.

Its 2:30 in the afternoon and I have to

rush out in the middle of my history class.

My heart pounds like a drum. Fear and

worry overtake me. My head burns with

what feels like hot, boiling blood rushingup my head. Im confused and lost; I dont

know whats going on.

Finally, I arrive at the hospital. I sit outside

the waiting room with my older sister and I

began to weep silently. My sister yells at

me with frustration, Stop crying. Moms

going to be okay. Stay here till the doctor

comes. I have to go home and pick up dad.

Dr. Harrison walks down an infinite hallway

with his long white coat that nearly reaches

down to his feet. He comes with the bad news.

Im sorry to tell you this but your mom

has cancer. The hemorrhoid we found

turned out to be a tumor. I know that your

mom doesnt speak English, so can you

please interpret for her?

I dont like sitting in the hospital, and I feel

uncomfortable. I want to tell the doctor

that I dont want to be here. But since my

mom doesnt speak English, my sister

Janice and I are the only ones that can

help mom. The doctor looks at me and he

begins to talk about my moms medical

condition. He talks to me as simply as possible,

so I can understand the situation, and

says my mothers cancer would require

surgery and probably radiation and

chemotherapy treatments afterward. I amshocked. Surger y. Radiation. Chemotherapy.

Side effects. I cant even begin to think of how

Im going to tell my mom. All this information

is new to me; all those big words sound

horrible. And the doctor is expecting me to

tell mom this in Cantonese. I begin to

translate for my mom. She looks back at

me with watery eyes. I search for comforting

words in Cantonese that would help calm

her, but I am lost. Its hard enough to think

of the Cantonese terms for various organs,

for surger y and chemotherapy.

Instead, I describe the situation in basic

terms, and leave gaps in-between my

explanation. Since I dont know how to say

surgery, I tell her that there will be needles,

knives, tubes, and cuts into her body.

My mom bursts out crying, pushing me

away. She doesnt want to see anyone.

Queena Lu

Asian Week (May 18-24, 2001). Reprinted with

permission for non-commercial purposes.

AD-HOC INTERPRETER


CHILDREN: VOICES FOR THEIR PARENTS


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AD-HOC INTERPRETER QUESTIONS

1. Have you ever been in the position of interpreting for family and friends? If yes, what kind of

challenges did you face in those situations?

2. What are your thoughts about the young writer becoming the designated interpreter for her

mother? What kind of problems can potentially occur when children are asked to interpret?

3. Do you think its ever appropriate for adult family members to interpret? Do you think its ever

appropriate for minor children to interpret?


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You arrive at a clinic to interpret for a patient. You meet the patient in the waiting area and she

thanks you for coming but says your services wont be needed today because her 24-year-oldniece can interpret for her.

What are possible ways to handle this situation? What would you say to the patient in your

language of service, and her niece in English?

CASE STUDY 1: AD-HOC INTERPRETER


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You are attending a meeting on language access in health care. You happen to sit next to an

administrator of a hospital who finds out youre an interpreter. He tells you that theyre beginningto get in more Russian and Bosnian-speaking patients. But he says that it really hasnt been a

problem because these communities have such a strong sense of family that they generally bring

a daughter, son, or other family member who can interpret for them.

How would you respond?

CASE STUDY 2: AD-HOC INTERPRETER


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Put a check next to the statements that are true about each mode of interpreting. The number of

correct statements for each mode is in parenthesis.

Consecutive (check 4)

1. One person speaks at a time.

2. More than one person speaks at the same time.

3. This mode is usually less confusing and more accurate than the other modes.

4. This mode is commonly used in health care interpreting.

5. This mode takes more time.

Simultaneous (check 2)

6. This mode takes more time.

7. The interpreter interprets almost at the same time as the patient or provider is speaking.

8. The interpreter has to take notes.

9. This mode is useful when interpreting for a speaker, who is presenting at a meeting

or conference.

10. This mode is commonly used in health care interpreting.

Summary/Paraphrasing (check 2)

11. One person speaks for some time and the interpreter summarizes the main points at the end.

12. The least recommended mode in health care interpreting because of the great possibility

for making mistakes or leaving out important information.

13. This mode is used all of the time in health care interpreting.

Sight Translation (check 2)

14. Is the oral translation of a written document.

15. Is sometimes necessary when documents the patient must understand are not available

in his/her language.

16. This mode is rarely used in health care.

MODES OF INTERPRETING


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STANDARDIZED INTERPRETING PRACTICES

As stated in the California Standards for Healthcare Interpreters, the fundamental purpose of

health care interpreters is to facilitate communication between two parties who do not speak thesame language and may not share the same culture.

The standardized interpreting practices introduced in Unit 1 of the training are meant to support

the primary relationship between the patient and provider.

Explain how the following interpreting practices or protocols support communication and the

primary relationship between the patient and provider.

a. Using first-person voice:

b. Interpreting everything communicated (verbally and non-verbally) by patients and providers:

c. Positioning of the interpreter slightly behind the patient:


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START, STOP AND CONTINUE REFLECTION

Think about making an ongoing commitment to professional health care interpreting. Based on the

training so far, write down what you will start doing, stop doing and continue doing.

I will start...

For example: I will start to use first-person voice when interpreting.


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START, STOP AND CONTINUE REFLECTION (continued)

I will stop...

For example: I will stop adding information that was not said by either the patient or the provider.


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START, STOP AND CONTINUE REFLECTION (continued)

I will continue...

For example: I will continue to learn medical vocabulary.


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DIAGRAM

Translate the diagrams into your language of service. If you are unable to translate the diagram,

you should go onto the next section of this workbook and ask your trainer/teaching assistantsfor assistance.

Note: Discuss with your trainer, teaching assistant, or language coach recommended medical

language dictionaries and resources for health care interpreting.

Respiratory System(A Handout for Interpreters in Health)


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DIAGRAM

Nervous System(A Handout for Interpreters in Health)


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VOCABULARY WORDS

Can you say and use the following words in both English and your language of service? Check off

the vocabulary words that may be difficult for you and write them in either a notebook or on 3 x 5cards to study and review often:

EXAMPLE

Term

Pronunciation(s)

Translation(s)

Definition(s)

Own Sentence

Other:

asthma

az-ma

boomkin, soomkin

A chronic respiratory condition, allergic in origin, marked by labored

breathing accompanied by wheezing, constriction in the chest, and

often by attacks of coughing or gasping.

My friend has been suffering from asthma for a very long time, and more recently

she experienced a severe asthma attack that required her to be hospitalized.

Adenoid

Asthma

Bronchitis

Cold

Flu

Emphysema

Epilepsy

Sinusitis

Laryngitis

Hoarseness

Lung cancer

Meningitis

Migraine headaches

Pneumonia

Polio

Sore throat

Stroke

Tonsil

Tuberculosis


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TAPING

Exercise 1: Tape record yourself saying aloud the terms from the above diagrams and from the

vocabulary words list in both English and your language of service. How was your pronunciation?

Now try using them in a sentence. How did you do? Your trainer, teaching assistant, or language

coach will go over the work you have done here with your peers during the practice session for the

next training.

Exercise 2: Now tape yourself giving a pre-session introduction to both the patient and provider,

in both languages. How did you do? Did you include all the information recommended by the

curriculum? Share how you did with your trainer, training assistant, or language coach and peers

in the next training session.


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PARTICIPANT NOTES

CONNECTING WORLDS PARTIC IPANT WORKBOOK : UNI T 1

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Check the correct answer for each of the descriptions describing the roles of the health care interpreter.

1. Converts both verbal and non-verbal messages from one language to another.

Message Converter

Message Clarifier

Patient Advocate

2. Interrupts and asks for clarification.

Patient Advocate

Message Converter

Message Clarifier

3. Informs speakers that specific words or terms do not exist in the other language.

Message Clarifier

Message Converter

Patient Advocate

4. Intervenes when there appears to be confusion or misunderstanding, resulting from possibledifferences in cultural views between patient and provider.

Message Clarifier

Cultural Clarifier

Message Converter

5. Takes action to support the health and well-being of the patient, often going beyond

facilitating communication.

Message Converter

Message Clarifier

Patient Advocate

6. Is the role that patients and providers generally expect the interpreter to conduct.

Message Converter

Message Clarifier

Cultural Clarifier

7. Has the potential to have high impact on the patient-provider communication and interaction

since the interpreter plays a very active role.

Patient Advocate

Message Converter

Message Clarifier


ROLES OF THE HEALTH CARE INTERPRETER


UNIT 2


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BARRIERS

Check the best answer for each of the descriptions describing barriers/challenges to

effective communication.

1. Differences in languages spoken.

Language Barrier

Ambiguous Message

Individual Prejudice

2. Differences in the level of language spoken reflected in pronunciation and use of more difficult

vocabulary and grammar.

Cultural Barrier Register Barrier

System Barrier

3. Differences in culture.

Language Barrier

Individual Prejudice

Cultural Barrier

4. Lack of interpreter services at a health care organization.

Language Barrier

Regional Variations in a Language

System Barrier


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MESSAGE CONVERTER AND MESSAGE CLARIFIER INTERVENTIONS

Be prepared to share your interventions with other participants at the next training.

Even after providing a pre-session introduction and intervening a couple of times with gestures and

saying Please pause, the provider is not pausing frequently enough for you to interpret everything.

Write down what you could say to the provider in a polite, yet firm manner. Remember to use

third-person voice.

1. What would you say to the provider (in English):

The patient has used a term you believe is a term used in another region of the country. You thinkthe word refers to the inner thigh but youre not sure. Write down what you could say to the patient

in your language of service to verify or request explanation. Should you use third-person voice

when intervening?

2. What would you say to the patient (in your language of service):


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SELF-ASSESSMENT OF STANDARD INTERPRETING PRACTICES

The goal of this assignment is to help you identify which interventions you might need to concentrate

on and practice on your own, with other training participants, or with a language coach (if available).In the comment boxes, describe any difficulties you have with the intervention. Does it make a

difference whether you intervene with the provider (in English) or with the patient (in language

of service)?

1. Providing a pre-session introduction.

Needs a lot of work. I am not sure I understand

how to do this. This is very hard for me.

Needs some work. I understand how to do it,

but need more practice doing this.

Needs a little work. I can do this but needmore practice to become very comfortable.

Doesnt need much work. I am very comfortable

with this. It is easy for me.

2. Using first-person voice in interpreting.





Needs a little work. I can do this but need

more practice to become very comfortable.



3. Positioning myself slightly behind the

patient (when possible).

Needs a lot of work. I am not sure I understandhow to do this. This is very hard for me.



Needs a little work. I can do this but need more

practice to become very comfortable.



Comments:

Comments:

Comments:


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34

SELF-ASSESSMENT OF MESSAGE CONVERTER ROLE AND INTERVENTIONS

The goal of this assignment is to help you identify which interventions you might need to concentrate

on and practice on your own, with other training participants, or with a language coach (if available).In the comment boxes, describe any difficulties you have with the intervention. Does it make a

difference whether you intervene with the provider (in English) or with the patient (in language of service)?

1. Convert messages from one language to another

accurately and completely.





Needs a little work. I can do this but need morepractice to become very comfortable.



2. Manage the flow of communication: guide

speakers to pause.










speakers to take turns.









Comments:

Comments:

Comments:


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SELF-ASSESSMENT OF MESSAGE CONVERTER ROLE AND INTERVENTIONS(continued)


speakers to slow down. Needs a lot of work. I am not sure I understand


Needs some work. I understand how to do it, but

need more practice doing this.





5. Request repetition.









6. Guide speakers to address each other directly,

instead of the interpreter.









Comments:

Comments:

Comments:


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36

SELF-ASSESSMENT OF THREE STEPS FOR STEPPING OUT

OF THE MESSAGE CONVERTER ROLE

The purpose of this assignment is to help you identify which interventions you might need to concentrate

on and practice on your own, with the other training participants, and language coaches (if available).In the comments box, describe any difficulties you have with the intervention. Does it make a difference

whether you intervene with the provider (in English) or with the patient (in language of service)?

1. Step 1: Identify Your Messages by Switching

from First- to Third-Person Voice

Notify all parties (patients, providers, family members)

when you are speaking your own thoughts. Switch

from first-person voice to third-person voice when

identifying and sharing your own message.

Needs a lot of work. I am not sure I understandhow to do this. This is very hard for me.







2. Step 2: Share ALL Message with ALL Parties

Interpreters should interpret everything spoken by

all parties, for all parties (e.g., patient, provider,

family members). This includes ALL messages

from the interpreter, as well.








Comments:

Comments:


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SELF-ASSESSMENT OF THREE STEPS FOR STEPPING OUT

OF THE MESSAGE CONVERTER ROLE (continued)

3. Step 3: Step Back

Return to the Message Converter role when possibleand if necessary, let parties know.









Comments:


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38

SELF-ASSESSMENT OF MESSAGE CLARIFIER ROLE AND INTERVENTIONS

The purpose of this assignment is to help you identify which interventions you might need to concentrate

on and practice on your own, with the other training participants, and language coaches (if available).In the comments box, describe any difficulties you have with the intervention. Does it make a difference

whether you intervene with the provider (in English) or with the patient (in language of service)?

1. Ask the listener if he/she needs more information

or simpler explanation from the speaker.








2. Ask for clarification when I am unfamiliar with

terms or concepts.









3. Ask for clarification when the speakers

message is ambiguous.









Comments:

Comments:

Comments:


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SELF-ASSESSMENT OF MESSAGE CLARIFIER ROLE AND INTERVENTIONS(continued)

4. Explain to the listener that there is no direct

linguistic equivalent of a word/term, and askif the listener needs an alternate explanation

from the speaker.









5. Signal with parties when I step out of the

Message Converter role and speak my own

thoughts by using third-person voice.

Example: The interpreter requests/suggests/needs





Needs a little work. I can do this but need

more practice to become very comfortable.



Comments:

Comments:


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40

DIAGRAM

Translate the diagrams into your language of service. If you are unable to translate the diagrams

you should go onto the next section of this workbook and ask your trainer, teaching assistant, orlanguage coach for assistance.

Digestive System(A Handout for Interpreters in Health)


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DIAGRAM

Endocrine System(A Handout for Interpreters in Health)


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42

VOCABULARY WORDS

Can you say and use the following words in both English and language of service? Check off the

vocabulary words that may be difficult for you and write them in either a notebook or on 3 x 5cards to study and review often:

Cirrhosis of the liver

Diabetes

Food poisoning

Gallbladder problems

Heartburn

Hepatitis

Hernia

Hiatal hernia

Indigestion

Hemorrhoids (piles)

Stomach flu

Stomach ulcer

Other:


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VOCABULARY WORDS FOR PAIN

A. ENGLISH DESCRIPTIONS OF PAIN

Every language and culture has its own ways of describing pain. The table lists common terms

used in English to describe pain. How would you interpret them into your language of service?

1. Acute pain:

2. Burning pain:

3. Chronic pain:

4. Cramping pain:

5. Dull pain:

6. Piercing pain:

7. Pins and needles/prickly:

8. Radiating pain:

9. Sharp pain:

10. Shooting pain:

11. Stabbing pain:

12. Throbbing pain:


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TAPING

Tape record yourself saying aloud the terms from the above diagrams and from the vocabulary

words list in both English and your language of service. How was your pronunciation? Now try

using them in a sentence. How did you do? Your trainer, teaching assistant, or language coach

will go over the work you have done here with your peers during the practice session in the

next training.


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PARTICIPANT NOTES


46


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HEALTH BELIEFS AND PRACTICES


UNIT 3

Compare some traditional health beliefs and practices of the community for which you will interpret,

and that of the Western medical communitys beliefs and practices. Below are some possible topics

you may want to consider in your writing.

What causes people to get certain illnesses?

The kind of foods that may be good or bad for certain illnesses.

What causes fever?


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CO N N E C T I N G WORLDS PARTIC IPANT WORKBOOK : UN

Circle the statements that are the most appropriate.

1. Why is it important for health care interpreters to protect the confidentiality of health information?

a. Patients may delay or avoid care if they think that embarrassing information might leak out.

b. Patients may worry about rejection if others find out they have a disease that is highly

contagious or has a stigma attached to it.

c. To develop and maintain the trust of both patients and providers.

d. All of the above.

2. Once a patient dies or an interpreter stops working in the health care setting, the interpreter no

longer needs to protect the confidentiality of protected health information.

a. True

b. False

3. Which of the following is prohibited by patient confidentiality laws (HIPAA or CMIA) unless the

patient gives written authorization?

a. Interpreters sharing or using patients names and addresses to send them information

and advertisements for life insurance products and services.

b. Physicians sharing information about a patients case for training other physicians.

c. Providers mailing their patients information about a new low-cost car seat program for

low-income women.

d. Providers giving background information to an interpreter about the patients case before

the medical visit.

4. Which types of health information are protected by HIPAA or CMIA?

a. Electronic

b. Paper

c. Orald. All of the above

5. An interpreter discusses a patient case with her spouse and does not mention the patients

name but mentions where the patient works. Is this considered protected health information?

a. Yes

b. No

CONFIDENTIALITY


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6. Which of the following is protected health information?

a. A patients previous surgeries

b. When and where a patient will be undergoing a diagnostic procedure

c. The type of health insurance that a patient is using to pay for delivery of her baby

d. All of the above

7. Is it permissible for interpreters to share information with their supervisor or contracting agencies

regarding cancellations, no-shows, or a problem that occurred during the interpreting session?

a. Yes

b. No

CONFIDENTIALITY (continued)


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Reference the California Standards for Healthcare Interpreters Ethical Principle 1: Confidentiality and

Performance Measures to help you respond to the following questions:

1. How do you explain to the patient what confidentiality means in the health care setting?

(Write in your language of service, if possible. You may also audiotape your response.)

ISSUES OF CONFIDENTIALITY


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2. What if you have some personal information about the patient and the provider asks you for some

information on this patient, what would you say?

ISSUES OF CONFIDENTIALITY (continued)


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PARTICIPANT OUTLINE


DIAGRAM

Translate the diagrams into your language of service. If you are unable to translate the diagrams,


Heart(A Handout for Interpreters in Health)


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54

DIAGRAM

Eye(A Handout for Interpreters in Health)


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DIAGRAM

Auditory System(A Handout for Interpreters in Health)


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TAPING

Tape record yourself saying aloud the terms from the above diagrams and from the vocabulary

words list in both English and your language of service. How was your pronunciation? Now try

using them in a sentence. How did you do? Your trainer, teaching assistant, or language coach

will go over the work you have done here with your peers during the practice session in the

next training.


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PARTICIPANT NOTES


58


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PATIENT ADVOCACY


UNIT 4

Write your responses on the lines provided below.

1. What is a Patient Advocate?

2. What should an interpreter do if he/she wants to advocate for a patient?


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PATIENT ADVOCACY (continued)

3. What are the potential benefits of being a Patient Advocate?

4. What are the potential risks of being a Patient Advocate?


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Read the following article. Be prepared to discuss the questions that follow in the next training.

While waiting for a patient in the reception

area of one department in a major hospital,

I had the experience of hearing a receptionist

make a discriminatory remark. I had to think

on my feet how to handle the situation: I was

checking with one of the receptionists to see

if my patient's appointment was still on andto see if he'd arrived yet. This receptionist, I

had noted, spoke some Portuguese and

Spanish, and Tagalog too, I believe. I

assumed she was probably pretty broadminded,

given her language aptitude and develop-

ment. Upon conversing a bit, I realized she

had traveled widely, as well. But she then

went out of her way to indicate to me her dis-

dain for Mexican Spanish, which she said is a

lower version of Spanish, and that Mexicans"bastardize" real Spanish. I didn't know what

to say at that moment, but I realized I'd better

remain alert around this receptionist, since

most of my patients there are Mexican, and

she might manifest the prejudices she harbors

while speaking with them.

What did I do in this situation? Not much. I

definitely made a mental note of the incident.

I also mentioned it to another interpreter in a

casual conversation about language and our

work experiences. I did not make a written

record of the incident, something I later

wished I had done. Because there was no

patient at my side at the time, I didn't have

any immediate advocacy role to play, but I

remember thinking that with this receptionist's

perspective, there was a likely problem in her

relations with the general patient population.

I braced myself for what I would do in the

future if a problem came out in my presence,

or if I were to be consulted about any other

such problems in that department.

I also recognized that people need to havesome intellectual freedom, to formulate their

thinking about national and cultural differences,

and that while hearing this woman's views

surprised me, given her position and her language

abilities, I must say that on the positive side,

at least she puts out her opinion honestly,

rather than hiding her opinions and having

them fester. If I wasn't an interpreter in this

situation, I probably would have challenged

the view more perhaps asking what makesone form of the language more legitimate

than another, and who decides which form is

more legitimate? But because I was conducting

my work, and I see myself as a representative

of an agency (Asian Health Services), I chose

to withhold my opinions, since any expression

on my part would be a type of intervention, or

advocacy, and I hadn't had a chance to think

through whether it would be appropriate in

this type of situation.

In retrospect, I think this kind of comment

should be recorded in my paperwork for the

agency. Mainly, because it is not "personal"

it's not "my" experience, per se. It is an

objective occurrence in a work scenario. And

if this were to prove to be part of a pattern,

my notes would serve as documentation. The

ETHICAL DILEMMAS

WORDS CAN BE HARMFUL


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62

course of action I would recommend, given

what I mentioned about the need for intellectual

freedom, would not have any punitive character

whatsoever. I mean, when "Ebonics" was a

big issue in society, people debated it widely,

and I certainly encourage that type of "free-

wheeling" discussion, even and maybe

especially in the workplace. Maybe I would

suggest a discussion with the individual about

how sensitive people are to having their cul-

ture, including their language, judged that

these comments can be seen as put-downs,

which can have a negative impact on their

health care environment and their perception

of the quality of their care.

I continued to work occasionally in the same

environment, and since I was a little uncomfortable

with this woman due to her outlook being so

different than mine, I made a special effor t to

be considerate of her, so as not to sow division.

Unfortunately, a few weeks later, I had a very

similar experience as the first, again with the

same receptionist: I arrived and waited for a

patient. The patient, a Mexican woman, arrived.I did my introduction with her including the

parts about "complete and accurate" and "no

side talk. The patient and I approached the

receptionist so the patient could register. I

noticed the receptionist had a haircut, and I

commented that it looked nice (I don't

remember if I spoke English or Spanish, but

in any case, I made it transparent for the patient).

The receptionist, referring to her hair, grumbled,

"Oh, they messed it up." She stretched herneck forward to see the waiting room, and

turned to look both ways. Then she commented,

"There's none of them here," and loudly whis-

pered, "It's because they're Vietnamese!"

The patient saw the receptionist's behavior,

and heard the comment.

First of all, I felt somewhat irate. To me, this

was blatant racism, and I was sickened by having

to interpret the comment, which I basically did.

I felt embarrassed on behalf of the hospital,

too, because I felt they would not want to be

represented this way, and the receptionist does

have a role of representing the hospital. I

know my own anger level and I did not want

to provoke an immediate confrontation, so right

there, at the reception desk, I limited my

response, asking the patient, "Did you understand

what she said?" The patient said,

"Somewhat." I said, "I'll clarify exactly, in a

minute." I wanted to let the receptionist

know, in a non-provocative way, that her comment

would be shared, and imply that it may bescrutinized. I allowed the receptionist to complete

the registration of the patient. The receptionist

then directed the patient to sit in the section of the

room near her, to wait to be called by the doctor.

I led the patient to another section of the

room. I clarified exactly what was said. The

patient didn't like the comment either. I told

her I was not very surprised by this comment,

but very disturbed by it. That it's in line,unfortunately, with a view she expressed on

another occasion about Mexican Spanish

being inferior to Castilian Spanish. The patient

felt these comments were not appropriate,

given her position as a receptionist, but the

patient did not express any desire to confront

this problem.

So I realized that any further "advocacy" I

chose to pursue would be later, after I consultedmy employer. When I raised it with my employer,

I was a little surprised that their was no "pat"

answer no formula for dealing with this type

of situation. My team's coordinator found the

situation disturbing and thought-provoking,

and obviously took note of the situation with

an open mind hoping to develop an appropri-

ate response. She suggested I raise this type


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of question at the CHIA conference, so we

could get some broader vision and suggestions.

As far as the CHIA guidelines for how to

resolve such an ethical dilemma:

1. Ask questions to determine whether

there is a problem. Doubt existed after

the first incident, but the second

incident put the problem in clear focus.

2. Identify and clearly state the problem,

considering the ethical principles that

may apply and ranking them in

applicability. I did not question

WHETHER to interpret the comments,

because this is a patient's RIGHT, to

have complete and accurate interpre-

tation so they can make their OWN

decisions about their health care. I

allowed the patient to take the lead

role as far as whether to confront

on the spot. I wanted to help facilitate

the patient's comfort for their

appointment, recognizing that thePRIMARY relationship involved is

between the patient and the doctor as

the main provider in this case, rather

than with the receptionist, so I didn't

pursue it further when the patient

declined to pursue it. But I also felt

that in order for her to trust the hos-

pital's care that this receptionist's

views must be identified and criticized,

or else the patient might see thesecomments as representative of the

hospital's approach, and feel uneasy

there. I also wanted the patient to

know that she CAN rely on an inter-

preter to assist her with discrimination

she may encounter.

3. Clarify personal values relating to the

problem. I'm used to confronting in

situations, but I cannot substitute

myself for the patient, or for the role of

the agency I work for. Sometimes I

need to take a step back, especially

since I have very strong feelings about

discrimination.

4. Consider benefits and risks of alter-

native actions. I felt that the risks of

doing nothing more than I did, as far as

"on the spot," were minimal. But I felt

that with doing nothing more afterward,

the risk increases that these dis-

criminatory comments could socially

pollute the health care environment for

many patients seen every day at this

major hospital. A big risk of acting

impulsively to confront the racism,

however, would be that my actions

could back fire, contributing to a defen-

sive, punitive and repressive climate for

hospital workers, which would also

jeopardize patients, and could easily

jeopardize the trust being developed

by hospital staff for interpreters.

5. Decide to carry out the action chosen.

I am still contemplating the appropriate

course of action to take.

6. Evaluate the outcome and consider

what might be done differently next

time. I feel that the way I handled it in

the immediate situation was fine. The

receptionist is aware that I am alert to

her behavior. I have not done anything

to antagonize her or jeopardize her

position, so there is still room for

discussion on good footing in the

future. I raised this with my agency,

and together we are seeking an

approach to solve the problem.

A health care interpreter


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3. Are expressions, such as that made by the receptionist, common in society? Are they common

in a health care setting? What would you do if you were NOT an interpreter, but were present in

this situation?

4. Is there an appropriate advocacy role for an interpreter in this situation? If so, where would

you start? Whom would you approach? What course of action would you suggest he/she/they

follow? What results might you expect?


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66

5. If you were to decide not to do anything about this incident, what would be the worst-case

scenario? Best-case scenario?


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6. Would you interpret the remark regarding Vietnamese people? If there is an advocacy role for

the interpreter in this situation, how do you play it?

7. How does the patient fit into any potential advocacy scenario? Would you confront the receptionist?

What other avenues exist to remedy the situation?

ETHICAL DILEMMA QUESTIONS: SECOND ENCOUNTER

BETWEEN INTERPRETER AND RECEPTIONIST


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8. What is at stake if you advocate here? What is at stake if you don't? How do you rank options

and select the most appropriate role to play?


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1. Information about the risks and benefits of proposed treatments or procedures. Patients are

asked to sign whether they approve or decline a treatment.

Advance Directive

Informed Consent Form

Title VI of the 1964 Civil Rights Act

2. Provides guidance on the kind of medical care to provide a patient when that person can no

longer take part in his/her treatment options or decision-making process. There are two types

of directives (instructional and proxy), both are completed in advance of serious illness when

the patient can still state his/her wishes.

Advance Directive



3. Prohibits discrimination by programs receiving federal financial assistance examples of federal

assistance include Medicare Part A (hospitalization), Medicaid/Medi-Cal, and Maternal Child

Health grants. This law has been interpreted to mean that limited English speakers have a right

to bilingual services at no cost to the patient.



Advance Directive

CONSENT FORMS AND ANTI-DISCRIMINATION LAWS


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70

Read the statements below and check off what you, as the interpreter, should or should not do for

sight translating.

1. Make sure that the provider is available because the patient may have some questions.

Should do

Should not do

2. Ask the provider to summarize the document.

Should do

Should not do

3. Understand key words before sight translating them.

Should do

Should not do

4. Explain words that do not have the same meaning in the patient's language.

Should do

Should not do

5. Make personal comments about the information.

Should do

Should not do

6. Check to make sure that the patient understands the information.

Should do

Should not do

GUIDELINES FOR SIGHT TRANSLATION


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training so far, write down what you will start doing, stop doing and continue doing.

I will start...

I will stop...


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I will continue


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DIAGRAM

Translate the diagrams into your language of service. If you are unable to translate the diagrams,


Skeletal System(A Handout for Interpreters in Health)


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74

DIAGRAM

Urinary Tract System(A Handout for Interpreters in Health)


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DIAGRAM

Female Reproductive Organs(A Handout for Interpreters in Health)


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VOCABULARY WORDS

Can you say and use the following words in both English and your language of service? Check off

the vocabulary words that may be difficult for you and write them in either a notebook or on 3x 5

cards to study and review often:

AIDS (Acquired Immune Deficiency Syndrome)

Arthritis (joint disease)

Backaches

Bone disease (osteoporosis)

Breast cancer

Broken bone (fracture)

Bursitis

Condom

Crabs

Diaphragm

Dislocation

Enlarged prostrate gland

Fibroids

Gonorrhea (the clap)

Hernias (rupture)

Others:

Herpes 2

Hysterectomy

Incontinence

Kidney failure

Muscle spasm

Ovarian cyst

The Pill (birth control)

Pre-menstrual tension

Pulled muscle (muscle strain)

Sprain

Stone (Kidney and Bladder)

Syphilis

Urinary tract infection

Vasectomy

Yeast infection


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80

B. My way to stay healthy (exercise, watch movies, eat balanced meals, get adequate amounts of

sleep etc.)


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training so far, write down what you will start doing, stop doing, and continue doing.

I will start...

I will stop...


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I will continue


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Funded by:

connecting worlds workbook

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